A clinical grading system based on ultra-wide field retinal imaging for sunset glow fundus in Vogt-Koyanagi-Harada disease

Graefes Arch Clin Exp Ophthalmol. 2015 Mar;253(3):359-68. doi: 10.1007/s00417-014-2710-7. Epub 2014 Jul 15.


Background: To develop a grading system for sunset glow fundus (SGF) based on the results of ultra-wide field retinal imaging and to investigate the factors related to the severity of SGF in patients with Vogt-Koyanagi-Harada (VKH) disease.

Methods: Records of 55 eyes with VKH disease were retrospectively reviewed. All patients had undergone serial fundus photography, ultra-wide field retinal imaging and spectral-domain optical coherence tomography. The morphologic characteristics of SGF and associated features related to the severity of the condition were evaluated.

Results: Sunset glow fundi were classified into 3 groups based on the extent and severity of depigmentary changes: early (n = 7), intermediate (n = 10) and advanced (n = 20). Grade 0 indicates the absence of sunset glow appearance. Eyes with a higher SGF grade were more likely to exhibit chronic recurrence (P < 0.001) and an anterior chamber reaction ≥ 2+ (P < 0.001), and were less likely to exhibit exudative retinal detachment (P < 0.001) at the initial presentation. Higher grades were more likely to exhibit cataracts (P < 0.001), glaucoma (P = 0.010), patchy chorioretinal atrophic lesions (P = 0.012), depigmented atrophic lesions (P < 0.001), an increased peripapillary atrophy/disc area ratio (P < 0.001), a decreased subfoveal choroidal thickness (P < 0.001), more frequent uveitis recurrences (P = 0.012) and a longer disease duration (P < 0.001). SGF progression was faster in eyes with a longer active inflammatory period.

Conclusions: We present a simple and logical grading system for SGF as determined by using ultra-wide field retinal imaging. This grading system offers a means of assessing the degree of inflammation and facilitates speculation about the duration of VKH disease.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Female
  • Fundus Oculi*
  • Glucocorticoids / administration & dosage
  • Humans
  • Immunosuppressive Agents / administration & dosage
  • Male
  • Middle Aged
  • Photography
  • Pulse Therapy, Drug
  • Retinal Diseases / classification*
  • Retinal Diseases / diagnosis*
  • Retinal Diseases / drug therapy
  • Retrospective Studies
  • Tomography, Optical Coherence
  • Uveomeningoencephalitic Syndrome / classification*
  • Uveomeningoencephalitic Syndrome / diagnosis*
  • Uveomeningoencephalitic Syndrome / drug therapy
  • Visual Acuity / physiology


  • Glucocorticoids
  • Immunosuppressive Agents